DSpace Repository

Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome Treated Medically or with Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights from the AUGUSTUS Trial.

Show simple item record

dc.contributor.author Windecker, Stephan
dc.contributor.author Lopes, Renato D.
dc.contributor.author Massaro, Tyler
dc.contributor.author Jones-Burton, Charlotte
dc.contributor.author Granger, Christopher B.
dc.contributor.author Aronson, Ronald
dc.contributor.author Heizer, Gretchen
dc.contributor.author Goodman, Shaun G.
dc.contributor.author Darius, Harald
dc.contributor.author Jones, W. Schuyler
dc.contributor.author Aschermann, Michael
dc.contributor.author Brieger, David
dc.contributor.author Cura, Fernando
dc.contributor.author Engstrom, Thomas
dc.contributor.author Fridrich, Viliam
dc.contributor.author Halvorsen, Sigrun
dc.contributor.author Huber, Kurt
dc.contributor.author Kang, Hyun-Jae
dc.contributor.author Leiva-Pons, Jose L.
dc.contributor.author Lewis, Basil S.
dc.contributor.author Malaga, German
dc.contributor.author Meneveau, Nicolas
dc.contributor.author Merkely, Bela
dc.contributor.author Milicic, Davor
dc.contributor.author Morais, Joao
dc.contributor.author Potpara, Tatjana S.
dc.contributor.author Raev, Dimitar
dc.contributor.author Sabate, Manel
dc.contributor.author de Waha-Thiele, Suzanne
dc.contributor.author Welsh, Robert C.
dc.contributor.author Xavier, Denis
dc.contributor.author Mehran, Roxana
dc.contributor.author Alexander, John H.
dc.date.accessioned 2019-12-06T21:04:48Z
dc.date.available 2019-12-06T21:04:48Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/7628
dc.description.abstract Background: The safety and efficacy of antithrombotic regimens may differ between patients with atrial fibrillation (AF) who have acute coronary syndromes (ACS), treated medically or with percutaneous coronary intervention (PCI), and those undergoing elective PCI. Methods: Using a 2x2 factorial design we compared apixaban with vitamin K antagonists (VKA) and aspirin with placebo in patients with AF who had ACS or were undergoing PCI and were receiving a P2Y12 inhibitor. We explored bleeding, death, and hospitalization as well as death and ischemic events by antithrombotic strategy in three pre-specified subgroups: patients with ACS treated medically, ACS treated with PCI, and those undergoing elective PCI. Results: Of 4614 patients enrolled, 1097 (23.9%) had ACS treated medically, 1714 (37.3%) had ACS treated with PCI, and 1784 (38.8%) had elective PCI. Apixaban compared with VKA reduced ISTH major or CRNM bleeding in patients with ACS treated medically (HR 0.44, 95% CI 0.28-0.68), ACS treated with PCI (HR 0.68, 95% CI 0.52-0.89), and undergoing elective PCI (HR 0.82, 95% CI 0.64-1.04) (pinteraction=0.052); and reduced death or hospitalization in ACS treated medically (HR 0.71, 95% CI 0.54-0.92), ACS treated with PCI (HR 0.88, 95% CI 0.74-1.06), and elective PCI (HR 0.87, 95% CI 0.72-1.04) (pinteraction=0.345). Compared with VKA, apixaban resulted in a similar effect on death and ischemic events in the ACS treated medically, ACS treated with PCI, and elective PCI groups (pinteraction=0.356). Compared with placebo, aspirin had a higher rate of bleeding than placebo in patients with ACS treated medically (HR 1.49, 95% CI 0.98-2.26), ACS treated with PCI (HR 2.02, 95% CI 1.53-2.67) and elective PCI groups (HR 1.91, 95% CI 1.48-2.47) (pinteraction=0.479). For the same comparison, there was no difference in outcomes among the three groups for the composite of death or hospitalization (pinteraction=0.787) and death and ischemic events (pinteraction=0.710). Conclusions: An antithrombotic regimen consisting of apixaban and a P2Y12 inhibitor without aspirin provides superior safety and similar efficacy in patients with AF who have ACS, whether managed medically or with PCI, or those undergoing elective PCI than regimens that include VKAs, aspirin, or both. en_US
dc.language.iso eng
dc.publisher American Heart Association
dc.relation.ispartof urn:issn:1524-4539
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject DOAC en_US
dc.subject P2Y12 inhibitor en_US
dc.subject VKA en_US
dc.title Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome Treated Medically or with Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights from the AUGUSTUS Trial. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1161/CIRCULATIONAHA.119.043308
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE


Files in this item

Files Size Format View

There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record

info:eu-repo/semantics/restrictedAccess Except where otherwise noted, this item's license is described as info:eu-repo/semantics/restrictedAccess

Search DSpace


Browse

My Account

Statistics